Subpectoral Biceps Tenodesis of the Shoulder: Indications and Technique Options


      Subpectoral biceps tenodesis of the shoulder may be a useful tool that can address a wide range of disorders in the setting of pathology of the long head of the biceps tendon. Primary indications include (1) zone 2 or zone 3 tendon pathology and (2) failed previous proximal tendon tenodesis. Secondary indications include (1) an overhead athlete or thrower, (2) chronic tendinopathy, and (3) surgeon preference. A subpectoral technique allows tendon fixation directly posterior (deep) to the pectoralis tendon high in the bicipital fossa or in the mid fossa or fixation low in the fossa inferior to the pectoralis tendon (infrapectoral). Fixation technique options include an onlay suture anchor, onlay unicortical button, inlay bicortical button, or inlay interference screw. Potential surgical complications include humeral fracture, loss of fixation, tendon pullout or rupture, and neurovascular injury. Regardless of the specific location or technique used, subpectoral tenodesis is a valuable tool for the treatment of proximal biceps tendon pathology.
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        • Dickens J.F.
        • Kilcoyne K.G.
        • Tintle S.M.
        • Giuliani J.
        • Schaefer R.A.
        • Rue J.P.
        Subpectoral biceps tenodesis: An anatomic study and evaluation of at-risk structures.
        Am J Sports Med. 2012; 40: 2337-2341
        • Mellano C.R.
        • Frank R.M.
        • Shin J.J.
        • et al.
        Subpectoral biceps tenodesis with PEEK interference screw: A biomechanical analysis of humeral fracture risk.
        Arthroscopy. 2018; 34: 806-813
        • Nuelle C.W.
        • Stokes D.C.
        • Kuroki K.
        • Crim J.R.
        • Sherman S.L.
        Radiologic and histologic evaluation of proximal bicep pathology in patients with chronic biceps tendinopathy undergoing open subpectoral biceps tenodesis.
        Arthroscopy. 2018; 34: 1790-1796
        • Taylor S.A.
        • Fabricant P.D.
        • Bansal M.
        • et al.
        The anatomy and histology of the bicipital tunnel of the shoulder.
        Am J Sports Med. 2015; 43: 63-68
        • Taylor S.A.
        • Khair M.M.
        • Gulotta L.V.
        • et al.
        Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.
        Arthroscopy. 2015; 31: 215-224